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Comparative Effectiveness of Beta-lactam Versus Macrolide Monotherapy in Children with Pneumonia Diagnosed in the Outpatient Setting

Ambroggio, Lilliam PhD, MPH*†¶; Test, Matthew MD*; Metlay, Joshua P. MD, PhD; Graf, Thomas R. MD§; Ann Blosky, Mary MSRN, MHA§; Macaluso, Maurizio MD, DrPH†¶; Shah, Samir S. MD, MSCE*¶‖

The Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p 839–842
doi: 10.1097/INF.0000000000000740
Original Studies

Background: Most children diagnosed with community-acquired pneumonia (CAP) are treated in the outpatient setting. The objective of this study was to determine the comparative clinical effectiveness of beta-lactam monotherapy and macrolide monotherapy in this population.

Study Design: Children, 1–18 years old, with a clinical diagnosis of CAP at an outpatient practice affiliated (n = 71) with Geisinger Health System during January 1, 2008 to January 31, 2010 were eligible. The primary exposure was receipt of beta-lactam or macrolide monotherapy. The primary outcome was treatment failure defined as change in antibiotic prescription within 14 days of the initial pneumonia diagnosis. Propensity scores were used to determine the likelihood of receiving macrolide monotherapy. Treatment groups were matched 1:1, based on propensity score, age group and asthma status. Multivariable conditional logistic regression models estimated the association between macrolide monotherapy and treatment failures.

Results: Of 1999 children with CAP, 1164 were matched. In the matched cohorts, 24% of children had asthma. Patients who received macrolide monotherapy had no statistical difference in treatment failure regardless of age when compared with patients who received beta-lactam monotherapy.

Conclusion: Our findings suggest that children diagnosed with CAP in the outpatient setting and treated with beta-lactam or macrolide monotherapy have the same likelihood to fail treatment regardless of age.

From the *Division of Hospital Medicine, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts; §Population Health, Geisinger Health System, Danville, Pennsylvania; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; and Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Accepted for publication February 18, 2015.

Funding for this study was provided to L.A. from the Ruth L. Kirschestein National Research Service Award (NRSA T32HP10027-14-00), provided to S.S.S from the National Institute of Allergy and Infectious Diseases (K01 73729) and Robert Wood Johnson Foundation under its Physician Faculty Scholar Award and provided to J.P.M. from the National Institute of Allergy and Infectious Diseases (K24AI073957). The authors have no conflicts of interest or funding relationships relevant to this article to disclose.

Address for correspondence: Lilliam Ambroggio, PhD, MPH, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue ML 9016, Cincinnati, OH 45229. E-mail:

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